Who should be assessed for falls?: A guide for older adults and caregivers

According to the CDC, over 800,000 patients are hospitalized each year because of a fall injury, most often because of a head injury or hip fracture. Knowing who should be assessed for falls is the critical first step toward prevention and maintaining independence in older adulthood.

Quick Summary

All adults aged 65 and older should undergo an annual fall risk screening, with a more thorough assessment recommended if they report falling, feeling unsteady, or express a fear of falling. Assessment is also crucial for those with specific medical conditions or medication risks.

Key Points

• Annual Screening for 65+: All adults over 65 should receive a yearly fall risk screening by their healthcare provider.

• Consider a Multifactorial Assessment: A detailed evaluation is necessary for anyone reporting a fall, feeling unsteady, or expressing a fear of falling.

• Medication Review is Crucial: Many medications can increase fall risk due to side effects like dizziness; a healthcare provider should review all medications.

• Physical Tests Identify Risks: Simple physical tests, like the Timed Up and Go (TUG), can help identify issues with balance, gait, and strength.

• Environmental Safety Matters: Modifying the home environment to remove hazards is a key part of any fall prevention strategy.

• Fear of Falling is a Risk Factor: The psychological impact of falling can lead to reduced activity, which in turn increases actual fall risk.

Why Fall Risk Assessment is Crucial

Falls are a leading cause of injury and death among older adults. Many believe falls are an inevitable part of aging, but this is a dangerous misconception. By identifying individuals at risk through a proper assessment, healthcare providers and family members can implement targeted interventions to significantly reduce the likelihood of a fall. The consequences of a fall extend beyond physical injury, often leading to a fear of falling, which can result in reduced physical activity, social isolation, and a decline in overall quality of life. Understanding the various triggers and risk factors is essential for proactive care.

Who Needs a Fall Risk Assessment?

The simple answer is that all adults 65 years and older should be screened annually for fall risk. This recommendation is supported by leading health organizations, including the Centers for Disease Control and Prevention (CDC) and the American Geriatrics Society (AGS). Beyond routine screening, certain individuals warrant a more immediate and detailed multifactorial fall risk assessment. This includes:

• Individuals who have fallen: Anyone who has experienced a fall in the past year, even if it didn't result in an injury.
• Those with balance or gait issues: Anyone who reports feeling unsteady when standing or walking, or whose gait appears abnormal during a clinical observation.
• People with a fear of falling: A significant fear of falling can itself be a risk factor, leading to restricted activity and muscle weakness.
• Hospitalized patients: All inpatients aged 65 or older, and those aged 50-64 with conditions predisposing them to falls, should be considered at risk.
• Caregivers concerned about a loved one: If a caregiver notices a change in their loved one's mobility, balance, or confidence, they should bring it to the attention of a healthcare provider.

Key Components of a Multifactorial Assessment

A comprehensive fall risk assessment is not a single test but a thorough evaluation of an individual's health and environment. A healthcare professional typically conducts this assessment, which often includes:

Medical and Medication Review

• Chronic conditions: Identification and management of underlying health issues like arthritis, Parkinson's disease, or cardiac conditions that affect mobility and balance.
• Medication side effects: A complete review of all prescription and over-the-counter medications to identify those that can cause dizziness, drowsiness, or postural hypotension (a drop in blood pressure when standing).
• Vitamin D deficiency: Screening for this common deficiency, which can affect bone health and muscle strength.

Physical and Functional Evaluation

• Timed Up and Go (TUG) Test: This quick test measures a person's mobility. The person is timed as they rise from a chair, walk 10 feet, turn, walk back, and sit down again. A time of 12 seconds or more may indicate a higher risk.
• 4-Stage Balance Test: Assesses a person's ability to hold various standing positions, from feet side-by-side to standing on one foot.
• Gait assessment: Observation of walking pattern for any abnormalities.
• Visual acuity: A simple eye test can determine if poor vision is a contributing factor.
• Foot and footwear assessment: Evaluation of foot health and the appropriateness of footwear.

Environmental and Lifestyle Factors

• Home safety assessment: Identification of potential hazards like loose rugs, poor lighting, or lack of grab bars.
• Fear of falling: Assessing the psychological impact of previous falls and the resulting behavior changes.
• Lifestyle habits: Discussing alcohol use and overall activity levels.

Comparison of Screening vs. Multifactorial Assessment

To clarify the different levels of evaluation, here is a comparison of a simple screening versus a full multifactorial assessment.

Feature	Fall Risk Screening	Multifactorial Fall Risk Assessment
Purpose	To identify if a person is at risk of falling.	To conduct a detailed analysis of all factors contributing to fall risk.
Who It's For	All adults aged 65 and older, annually.	Individuals who fail the initial screening or have specific fall-related concerns.
Method	Simple questions about falls in the past year, unsteadiness, or fear of falling.	Comprehensive evaluation including medical history, physical exams (TUG test, etc.), medication review, and home safety checks.
Initiated By	Primary care provider during a routine visit, or by a caregiver.	Healthcare professional with specific training in fall prevention.
Outcome	Results in either a "low risk" designation or a recommendation for further assessment.	Produces a personalized, multi-pronged intervention plan.

Practical Steps for Caregivers and Family

If you are a caregiver for an older adult, being proactive can make a significant difference. Start by observing your loved one's movements. Do they seem unsteady? Do they grip furniture when walking? Bring these observations to their healthcare provider. It's also important to have open conversations about past fall experiences, which are often not reported. For comprehensive guidance on prevention, the CDC's STEADI initiative offers excellent resources for both clinicians and patients, including screening tools and educational materials. STEADI (Stopping Elderly Accidents, Deaths, and Injuries) is a great place to start your research.

Taking Action After the Assessment

Once a fall risk assessment is complete and a risk level is identified, the next steps are crucial. For those at low risk, maintaining an active lifestyle and staying vigilant about home safety is recommended. For those at higher risk, a tailored intervention plan is needed. This might include a referral to a physical or occupational therapist for gait and balance training, a review and adjustment of medications, or specific home modifications. The key is consistent follow-through and ongoing monitoring to ensure effectiveness and adapt as needs change.

Conclusion

Preventing falls is a team effort involving individuals, caregivers, and healthcare professionals. Knowing who should be assessed for falls—annually for everyone 65 and older, and immediately for those with known risk factors or incidents—is the most powerful tool in reducing the devastating impact of falls. Proactive screening and comprehensive assessment, followed by tailored interventions, can help older adults maintain their independence, safety, and confidence for years to come. Do not wait for a fall to happen; assess the risk now and take preventative action.

Frequently Asked Questions

What is the primary indicator that someone needs a fall risk assessment?

The primary indicator is being 65 years or older. Additionally, a fall within the past year, even a minor one, is a strong signal for a comprehensive assessment.

Can I perform a fall risk assessment at home?

While a healthcare professional must conduct a full multifactorial assessment, you can use simple tools like the CDC's STEADI brochure to perform an initial screening at home. This can help you identify concerns to discuss with a doctor.

What does a multifactorial fall risk assessment include?

It includes a medical history review, medication analysis, physical tests for balance and gait, a vision check, and an evaluation of the home environment for safety hazards.

Is it true that a fear of falling can increase my risk?

Yes. A fear of falling can cause a person to limit their physical activity. This leads to muscle weakness, a decline in balance, and reduced mobility, all of which increase the actual risk of a fall.

Are younger people ever assessed for fall risk?

Yes. While the focus is often on older adults, a fall risk assessment may be recommended for younger individuals with specific underlying medical conditions, such as Parkinson's disease, certain neurological disorders, or those with significant medication risks.

How often should fall risk assessments be done?

For all adults 65 and older, a screening should be done at least once a year. For those identified as high-risk, a more frequent and detailed assessment schedule will be recommended by their healthcare provider.

What is the Timed Up and Go (TUG) test?

The TUG test is a standard assessment tool where a person is timed as they stand from a chair, walk 10 feet, turn, walk back, and sit down. If the test takes 12 seconds or longer, it suggests a higher fall risk.